Respiratory care
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Pediatric extubation failure is associated with morbidity and mortality. The most common cause is upper-airway obstruction. Subglottic edema is common, but upper-airway obstruction can occur from the oral cavity to the trachea. Dichotomous categorization of extubation failure as airway versus non-airway may help identify risk factors as well as strategies that translate to lower extubation failure rates. ⋯ Airway extubation failure prevalence was 1.5 times higher than non-airway failure. Potential risk factors for airway failure were identified. These findings are hypothesis generating for future study focused on key evidence gaps and pragmatic bedside application.
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Observational Study
Oxygen Desaturation and Persistence of Symptoms during Activities of Daily Living in Patients following Hospital Discharge for COVID-19.
COVID-19 can cause respiratory and multisystemic impairments, which lead to impaired activities of daily living (ADL). Telemonitoring after discharge from the hospital may help identify the persistence of such limitations during ADLs simulations. The aim of this study was to compare SpO2 , fatigue, and dyspnea through telemonitoring during a battery of 4 ADLs in patients following hospital discharge for COVID-19. ⋯ SpO2 was similar among the ADLs but walking triggered desaturation in a larger number of subjects. The subjects presented with mild-to-intense fatigue and dyspnea during ADLs 30 d after discharge after hospitalization for COVID-19 regardless of desaturation status, which demonstrated that the persistence of symptoms is independent of hypoxemia during exercise.
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Postextubation stridor (PES) is an imminently life-threatening event. Maximizing patient safety requires a systematic approach to screen patients for PES risk factors and a standardized test to evaluate that risk. This retrospective study of adult subjects was based on quality assurance data including standardized surveillance screening criteria and a volume-based cuff leak test (CLT) to evaluate PES risk among predominantly surgical-trauma and neurotrauma subjects. Data characterizing PES subjects also were collected. ⋯ Among predominantly surgical-trauma and neurotrauma subjects with a CLT, leak volume of ≥ 110 mL was associated with a PES risk of ∼6%, whereas the risk of PES was 7 times greater when the leak volume was < 110 mL.
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Intermittent mandatory ventilation (IMV) is one kind of breath sequence used to classify a mode of ventilation. IMV is defined as the ability for spontaneous breaths (patient triggered and patient cycled) to exist between mandatory breaths (machine triggered or machine cycled). Over the course of more than a century, IMV has evolved into 4 distinct varieties, each with its own advantages and disadvantages in serving the goals of mechanical ventilation (ie, safety, comfort, and liberation). ⋯ Also included is a brief overview of the background information required for a proper perspective of the purpose and design of the innovations. Understanding these different forms of IMV is essential to recognizing the similarities and differences among many dozens of different modes of ventilation. This recognition is important for clinical application, education of caregivers, and research in mechanical ventilation.
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Observational Study
Concise Versus Extended Lung Ultrasound Score to Monitor Critically Ill Patients With COVID-19.
Lung ultrasound (LUS) can be used to monitor critically ill patients with COVID-19, but the optimal number of examined lung zones is disputed. ⋯ Concise LUS was equally informative as extended LUS for monitoring critically ill subjects with COVID-19 in supine or prone position. Clinicians can monitor patients undergoing position changes but must be wary that LUS score index alterations may result from the position change itself rather than disease progression or clinical improvement.